Monday, December 24, 2018

Italian public hospital
doctors tend to despise general practitioners, resent private physicians, and defend
their realm from both. One time a patient came to my office in obvious need of
immediate abdominal surgery. I shipped him off to the Emergency Room with a
referral letter, heard from the family that some kind of operation had been
done, tracked down the surgeon on the phone – and the guy refused to tell me
what he found.

During my residency in New York City
hospitals our attitude wasn’t much different. Our self-importance was reflected
in the sneering phrases we used to refer to outsiders. “Saint Elsewhere” was
resident slang for a humbler hospital that had, in our opinion, mishandled a difficult
patient and then punted him or her over to our training institution for us to
patch up (New York hospitals’ saints included Anthony, Barnabas, Clare,
Elizabeth, Giles, Joseph, Luke, Mary, Vincent, and a whole host of Johns).

“LMD,” short for “local medical
doctor,” referred archly to a patient’s outside physician, always presumed to
be an idiot. A typical emergency room medical history: “3 days ago 105º fever
and difficulty breathing. LMD prescribed aspirin over the phone.”

Being on the other side of the divide,
now that I’m an LMD myself, isn’t easy. When I’m trying to get an update on a
patient of mine who’s been admitted to one of Rome’s public hospitals, I do
everything to avoid the categories of either competitor or smarty pants. The
best results come if I have a friendly colleague who works in the hospital go and
spy. When there’s no inside informant for me to turn to, I’ll make diplomatic phone
calls attempting to cajole the hospital docs into giving me information, on
grounds ranging from the patient’s embassy has asked to be informed, to the
relatives are pestering me from the States, to the patient doesn’t speak a word
of Italian. Whatever I can think of.

This can lead to dangerous
pussyfooting around which at least once, back in the ‘90s, led to dire
consequences. I gave in to the pleas of the worried wife of one American
tourist, who was in the Santo Spirito Hospital’s intensive care unit for chest
pain, and agreed against my better judgment to make a trip to the hospital to
take a look. Once there I played super-nice with the house physicians to avoid
offense: I merely glanced at the blood test results, I read the x-ray reports without
looking at the actual films, and I listened respectfully to the staff’s reassuring
conclusions. I backed the hospital docs up all the way, and told the patient’s
wife that since he hadn’t had a heart attack he'd surely be able to fly home in
a couple of days.

Well, that patient died ten hours later,
of a ruptured aortic aneurysm, when a segment of the body’s main artery has
ballooned out as it exits the heart, and bursts. This is a major emergency that
can often be diagnosed or at least suspected from a simple chest x-ray, and
could have been cured by surgery. I was devastated. When a fit of masochism
sent me back to the hospital the next day to take a look at the x-ray I had
skipped on my previous trip, the diagnosis seemed obvious. But without knowing
the answer ahead of time would I have gotten it right just by looking at the
film? Was the patient’s death chiefly the fault of the hospital doctors’ failure
to make the diagnosis, or was it my own fault for the insecurities that had
made me suck up to the hospital staff and the family rather than be thorough?
Writing about it now 20 years later I still shudder with guilt.

Wednesday, December 5, 2018

Americans who knew something about
Italy used to nod knowingly when I’d tell them the National Health Service was
going from bad to worse, saying: “Ah, that bastard Berlusconi.” Not so. Silvio
Berlusconi, small-minded as he may have been as on-again-off-again Premier
between 1994 and 2011, did relatively little harm to the health care system; his
political
program never went far beyond (1) keeping himself out of jail and (2) getting
to paw lots of women, the younger the better. By the time Angela Merkel and
the European Bank maneuvered the Italians into giving
Berlusconi the boot, he had made only a few timid cuts in public medicine.
It was Merkel’s more respectable buddy Mario Monti, the sober economics
professor she and the other Europeans installed to take over from Berlusconi as
Prime Minister, who proceeded to force austerity with a vengeance on Italian
regions in deficit, which meant most of them. Poof!
there went the hospital beds, and the staffing, leaving patients amassed on
gurneys in emergency room halls. Mario did more damage to ordinary Italians’
health care in one year than Silvio had in seventeen.

Seven years down the line, there’s
been another game-changing shift in Italian politics, including medical
politics. This time, though, the protagonists are dangling pledges to spruce up
the National Health Service rather than vowing to undermine it. The right-wing
League and the no-wing Five-Star Movement, the two parties currently – and improbably
– sharing power, have made rosy joint promises
to restore funding for the public medical sector, fight corruption, and improve
services. Plus promising their constituents everything from earlier retirement
to a guaranteed minimum income.

But it’s all pie in the sky,
based on a magic trick. At the same time as the Five-Star people campaigned on
beefing up the welfare state, their buddies in the League were swearing to slash
taxes for businesses. When they cobbled together a government, each party stuck
to its own promises, despite the glaring contradiction between taking in less
and spending more. European Union economic authorities did some arithmetic and turned
thumbs down. The Italians have so far dug
in their heels. Who will blink? Will the National Health Service ever
receive that badly-needed infusion of cash? At this point it’s anyone’s guess,
but I wouldn’t hold my breath.

Sunday, November 25, 2018

Stay with me on this one, it’s worth the trouble – all
you need to know about Italy in a single story.

ENPAM (Ente Nazionale di Previdenza ed Assistenza
dei Medici), the physicians’ pension fund, allows its members to pay in
retroactively to cover the time they spent at university. This riscatto della laurea, “redeeming your
degree,” lengthens your pensionable working life by six years and yields a healthy
boost to your pension.

In one of those mysteries of Italian bureaucracy,
ENPAM assured me early on that they would let me redeem all six years of
Italian medical school, even though
I’d only actually been enrolled for 11 months (taking courses not required for
my American MD). I could never quite afford the riscatto, though – the cost crept up year by year slightly faster,
in proportion, than my income.

In 2004 an office-mate tipped me off that
there was a half-price
sale on the riscatto della laurea. I
leapt at the chance, and headed off for ENPAM central, a vast labyrinth. A
receptionist pointed me toward the riscatto
office, and after hiking up one corridor and down another for ten minutes,
asking directions repeatedly along the way, I reached a corner room with the
right number pasted outside. There a kindly official sat me down, patiently
explained the riscatto, confirmed
that the cost was temporarily 50% of normal, calculated my reduced monthly
payment, handed over the sheet of paper with his scribbled calculations, and helped
me fill out the application. After I had signed, he kept it.

Three months later my first bill arrived, for
exactly double the figure he’d written down, and more than I had in the bank.

I phoned ENPAM the next day. The employee who
fielded my irate call said the higher bill I’d received in the mail was
correct. Half-price sale? What half-price sale? There had never been, nor could
there ever be, such a “sale.” Who on earth had told me otherwise? I described
the location of his office and the position of his desk. Long pause. Then, “Aaa, allora si capisce,” oh, that
explains it. The helpful gentleman in question, she volunteered, had been off
on prolonged sick leave and since returning to work was not quite right in the
head…

In other words: an employee known to be incompetent
had been allowed back on the job. Italian compassion. Once back, he was
permitted to hand out major-league misinformation. Classic pressappochismo (literally more-or-less-ness, or sloppiness). And
his colleague, gifted with Italian courtesy, had no compunction about telling a
stranger all about it over the phone. A bad joke, with a worse punch line: the
application I’d been misled into filing and then had to cancel counted as my
once-in-a-lifetime chance at the riscatto.
I was doomed to a pension without benefit of those six extra years.

Sunday, November 11, 2018

Laura Salpietro, 30,
had been rushed to hospital after her waters broke, but as she lay on a bed in
agony, doctors argued over whether to deliver her first child naturally or by
caesarean. Amazingly, the row then became violent, with punches thrown while her
horrified husband Matteo Molonia, 37, looked on, pleading for the medics
to stop and help his wife.

– Daily
Mail, byline Sicily, 2010

*
* *

The Italians I have known and loved are fun, funny,
cynical, flirtatious, spontaneous, determined not to let their work interfere with their lives. It occurred to me, as
I waited for the anesthesia to turn out the lights, that none of these were
qualities I wanted when it came to my health care.

–
Holly Brubach, New York TimesSunday Review, 2014

We all know what doctors are like. Compulsive sons of bitches, anal retentive,
detached, perfectionist, tough on themselves, insufferable with others, models
of dogged stick-to-it-iveness and preternatural calm. In Italy? Some yes, some no...

Wednesday, October 24, 2018

When I was a kid we
lived in the Pomonok housing
project in Flushing, Queens, a half hour’s subway ride from Times Square, long before
the projects turned dangerous or the borough went Asian. The car-free
playground just out the door always offered a glorious assortment of games, and
after school I’d play punchball
with a spaldeen, run
bases, shoot marbles, play jacks, or jump rope with a clothesline chanting
“Policeman policeman do your duty, Here comes Susie the American beauty” until
my father whistled out the window or it was too dark to catch the ball,
whichever came first. My usual means of transport was clamp-on
roller skates.

Jack the Ice Cream Man,
a neighborhood institution, didn’t only sell popsicles and chocolate
marshmallow push-up sticks, he also organized races and yo-yo contests, with
bird whistles and glow-in-the-dark plastic skulls as prizes.

Everyone stayed home from school on
the Jewish holidays, even the black kids, with the exception of me and a few
other red diaper babies unfortunate enough to have principled left-wing parents.
I remember two ways a marginally better-off kid might lord it over the rest of
us: to own a baseball glove, and to play potsy (that’s Queens for hopscotch) by tossing a red checker
instead of the standard-issue bottlecap onto the squares.

There were other tomboys on the
playground, but I was the only one who convinced my mother to let me wear boys’
shoes under my dresses – in the fifties that meant not sneakers but Buster Browns with leather soles –
so I could run faster.

We had a piano for my father to play Bach, Mozart, and Count
Basie. At age four I sat down on the stool like he did and slammed my open hands
on the keyboard expecting music to come out – I still remember my shock at the
cacophony! I got to start piano lessons afterward, learning to read notes about
the same time I learned to read words.

In 1954 I was scheduled to be a
guinea pig for the Salk polio vaccine but I hated injections (I still do,
that’s why I’m so good at giving them). My mother spent hours giving me
make-believe shots with a bobby pin so I wouldn't pull my arm away at the
moment of truth. She told me I had to get used to needles because I would need
them to take away the pain of having a baby – an issue fresh in her mind since
my little brother was just two years old. At the last minute I caught a cold
and didn't get the vaccine after all, disappointing everyone except myself.When they taught us in medical school that some
of those first batches hadn't been adequately inactivated and had given lots
of kids paralytic polio, I took it as a sign of personal grace.

My health suffered no serious threats. Perpetual scabs adorned my
knees – when my mother once hinted there would come a day when I would no
longer have them, I didn’t believe her. I landed on my coccyx roller skating
and couldn't sit down for a week, I split my chin open showing off at potsy,
and there were warts to paint, but no broken bones and no appendicitis. I even
managed to hang on to my tonsils.

Pomonok has changed some, but – according to one contented denizen
recently – “Residents are born, raised,
and never leave here!” So next time you hear anyone badmouthing “the
projects” maybe you’ll remember my
project: kiddie heaven.

Wednesday, October 10, 2018

In Italy as in Tony Soprano’s New Jersey, the garbage business is
traditionally in the hands of the Mob.

The ubiquity of organized crime is
no surprise when it comes to Italy's South, cradle of the Mafia and its regional
offshots. Nobody’s shocked to hear that the Calabrian ‘Ndrangeta runs hospital
kitchens and has the corner on artificial limbs. It’s par for the course if Goodfella
funeral directors wander the hospital wards in Naples with impunity in search
of imminent cadavers to snatch, or if Sicilian regional administrators let
public hospitals deteriorate so their Mafioso friends can build private ones. But
when we read reports of Mafia-owned businesses getting the contracts to build
and renovate hospitals in previously off-limits northern cities like Verona,
Savona, and Milan, I for one find it frankly amazing.

Convicted Mafia bosses are always getting assigned to house
arrest instead of prison on the grounds of ill-health. Failing which, they arrange
transfers from jail to cushy private hospitals on trumped-up medical excuses. One
easy trick is to buy off a surgeon to perform a biopsy and then switch the
histological slides, so the pathologist will diagnose a healthy boss as having
cancer. In my favorite case the gentleman had been passing himself off as a
kidney dialysis patient. When a suspicious judge sent around an inspector to check
with his own eyes that the near-death lab specimens came, indeed, from the man
of honor, cooperative doctors rigged up a bag containing the blood of a real
dialysis patient on the boss’s back and ran a catheter down through the sleeve
of his hospital gown. That way a nurse who was in on the scam could by a little
sleight of hand draw a diseased blood sample, in front of the inspector’s eyes,
from the plastic tube instead of the vein.

Monday, September 24, 2018

My patient Gayle
lived hand to mouth with an Italian mechanic boyfriend, her sole income selling
homemade preserves at the weekly village market. She decided to consult me after
giving up on her National Health Service General Practitioner: she’d been
experiencing gnawing abdominal pain for months, then started having bloody
diarrhea. It was obvious that she needed colonoscopy to figure out what was
going on, and fast, but how was she to get one? Her local public hospital had
an eight-month waiting list, and she couldn’t afford €900 to have it done in
the private clinica I usually
recommend.

Gayle asked around and found a
cut-rate private operator who quoted her €250. I turned thumbs down at her
doing such an invasive procedure with someone I didn’t know – I’ve seen too
many colonoscopies gone wrong. Sometimes the doctor got only halfway up the
colon and turned back. Other times he or she saw polyps but left them in place
instead of removing them, or omitted biopsies that need doing. In the worst
case, a hole was poked right through the bowel wall.

Next I asked my trusted gastroenterologist
colleague whether he could get her hospitalized on the public ward where he
worked. He rolled his eyes and told me his hospital was so short of beds that
an ulcerative colitis patient of his was parked at that very moment in the Emergency
Room hallway with a high fever, passing bloody diarrheal stools every hour,
waiting for a hospital bed to open up and in the meantime getting no treatment
at all. No chance that my patient, who was sick but not at death’s door, could
get admitted.

For decades, there’s been a
tug-of-war on between full-time National Health Service hospital doctors who
want to supplement their salaries with private practice, and governments that
aim to keep public medicine strictly public. An uneasy compromise lets hospital
docs see paying patients, but – theoretically – only inside the hospital. This
has been dubbed intramoenia, Latin
for within the walls. If you get a colonoscopy on the public system you’ll pay
next to nothing, but unless you arrange it a year ahead of time you’ll feel
every painful twist of the tube. If you do your colonoscopy privately in the
same hospital, with the same gastroenterologist, in intramoenia, an anesthesiologist will be glad to knock you out for
the duration.

In their battle to hold on to outside
offices, the physicians have found strange bedfellows in the left-wing hospital
workers’ trade union, which opposes on principle the mixing of public and
private medicine on hospital grounds. Both groups have been appeased by a
sleight-of-hand redefinition of “hospital grounds” that can stretch to include offices
anywhere in town…

Back to Gayle. My trusted colleague
eventually came up with a splendid solution: he referred her to his own trusted
colleague who did the exam on intramoenia
three weeks later for €450, about what Gayle and her boyfriend could scrape
together. The diagnosis? Crohn’s disease, which now that it had been diagnosed
could be treated perfectly well in the public system where she doesn’t have to
pay a penny. Much of my professional life is spent helping patients run this
kind of daily slalom between public and private medicine. Quite a job in its
own right.

Sunday, September 9, 2018

He’s a dermatology
Chief Of Staff, she’s a prominent psychoanalyst, both have offices in their
mammoth apartment in a classy Rome neighborhood. One afternoon she greeted a
new patient, had him lie down on the analytic couch, and got him talking. For
20 minutes she listened from behind his head, emitting an occasional “um-hmm,”
then made a first stab at an interpretation: “You seem very focused on your
psoriasis. I wonder what all this concern might come from.” He replied, “Of
course I’m focused on my psoriasis, that’s why I took an appointment with the
dermatologist.” This is a true story.

Welcome back to Stethoscope On Rome! As an adoptive Italian I wouldn't dream of posting in August...

Thursday, July 19, 2018

Date: December 24, 1994. Place: Indian
Springs Spa, Calistoga, California, two hours north of San Francisco. My
second-husband-to-be Alvin Curran and I emerged from our mud packs so blissed
out we couldn’t imagine trudging back down to where we were staying in the city,
so we asked for a room for the night. “All booked up,” replied the receptionist
from under her teased beehive, “And since it’s Christmas Eve so will be everywhere
else in town that has a hot pool.” We kept pestering her until she admitted,
“Well there is this one place, a good 45 minutes from here, they might have
room. But it’s kind of, umm, funky.”

I dialed the number. Yes, they did
have hot spring water and yes, they did have a free room. “We have a problem,
though,” I said. “We only meant to go to Calistoga for mudpacks, so we didn’t
bring any bathing suits along.” “Oh, that’s ok,” said the voice, “We can arrange
something.”

The drive took a solid hour through driving
rain, over roads that shrank to lanes then to trails, and by the time we handed
over our parking fee at the gate of Harbin Hot
Springs night had fallen. As we inched forward through the mud, pale figures
began to emerge from the darkness, swinging flashlights, and sporting boots but
not another stitch of clothing. Both “funky” and “we can arrange something”
suddenly made sense: this joint was nudist!

The next morning as we stood soaking
to our chins along the edge of the warm pool, exchanging smiles with
fellow-hedonists, a burly fellow climbed in as naked as the rest of us, scanned
the faces, chose mine, and extended his hand saying, “You look like you could
use a watsu.” “A what?” “Close your eyes and I’ll show you…” The WATer shiatSU treatment
he gave me, swishes and stretches and massages on the surface of the water, was
a blissful pas de deux that must have lasted only ten minutes but felt like
forever. In my life I’d had lots of massages and other kinds of body work,
but watsu was in its own league.

As I later learned, watsu was invented in the early 1980s by Harold Dull, who moved
to Harbin after making his name as a poet in San Francisco. His inventive
spirit transported zen
shiatsu, which he had studied in Japan with its inventor, Shizuto Masunaga,
to the warm spring waters of the hippie spa. The experience is relaxing and
energizing at the same time, somewhere between meditating, flying, and dropping
mescaline. At least that’s what it felt like to me.

After some years of making runs up to
Harbin every time I was in California, in 2000 I decided I’d try seeing what it
was like to take on the other role. Giving watsu treatments turned out to be
nearly as mind-blowing as receiving them, and three hundred hours of training later
I was ready to start practicing bodywork on days I wasn’t seeing patients with colds and cystitis.

There was only one hitch: finding the
right pool. A watsu pool has to be large enough to swing a client around, calm
and quiet enough to permit complete relaxation, just the right depth, and just
the right temperature (34º-35º Centigrade, 93º-97º Fahrenheit). Jacuzzis are
too small, heated swimming pools not heated enough. Italy’s many famous hot
springs can be great for watsu, but the closest to me is an hour and a half drive.

After an exhaustive hunt I found a
place inside Rome that qualified, barely: an off-kilter urban spa provocatively
named Extasia. The water was so shallow I had to work literally on my knees, and
the risk that my client might get skewered on a sharp corner that stuck out
into the tiny pool kept me figuratively on my toes. Plus we all couldn’t help
but notice one tall white-coated employee who was always popping in and out of
the reception area, sporting a short skirt and a strangely prominent Adam’s
apple. I did manage give a couple of dozen sessions…

…until one day I heard the place had
been closed down – by the vice squad. When eventually they did re-open, they
thought it more prudent to bar outside therapists.

I moved on to the lovely swimming
pool in the basement of the Grand Palace Hotel on Via Veneto, which they were
willing, for a reasonable sum, to heat to watsu temperatures on special
request. But around 2010 it too closed down, voluntarily, and when it reopened two
years later the new management couldn’t be talked into hosting such a
suspicious-sounding activity as water-based massage. Alas, I don’t yet have a decent
substitute yet anywhere in Rome – the only appropriate pool I’ve found prices
itself out of the running. All suggestions are welcome.

Saddest of all, my beloved Harbin Hot
Springs was destroyed in the northern California fires of 2015. It is still
struggling to rebuild.

Monday, July 9, 2018

If I had felt like
it, when I opened my medical office for business on Rome’s Via Scialoja in 1980
I could have set up a double-duty exam table that tilted thisaway for me to
take your Pap smear and thataway for me to fill your cavities. True, most dental
drills in Italy even back then were wielded by guys who had gone through all
the paces: first a regular medical degree, then a book-based specialization in
teeth, finally a practical apprenticeship with a dentist father or family
friend to actually learn the job. But a good chunk of the Dentista offices were run by . . . General Practitioners, who
rounded out their income with improvised odontoiatric skills. Until 1984 anyone
who had graduated from medical school could legally set up shop as a dentist in
Italy, without having done a specialization and without any hand-in-mouth
training whatsoever. It must have taken nerves of steel. By now, thankfully,
that cohort of medical moonlighters are almost all retired.

In Italy the default for doctors and hospitals is public, but the
default for dentists is private. For one thing the waiting list for dental work
on the public health system can be two years long, and for another NHS dentists
are notoriously "cavadenti"
who yank teeth instead of fixing them. So whereas private medicine in Italy is largely
for the well-to-do, private dentists cater to the masses. But – paradox – they
charge twice what they do in the States. The circle is squared by a semi-clandestine
horde of cut-rate imposters – as per one
of my first blog posts.

(There are phony physicians too, of course. One Roman
pseudo-doctor, unmasked after 15 years of practice, rode off into the sunset on
his bicycle. Two months later a clochard died of exposure on the steps of a
noble Palazzo: it was him. But, then, in
2003 Florida alone convicted 101 fake physicians, so we can confidently
guess that right this moment thousands of charlatans are practicing medicine
without a license in the US.)

Nino Campanelli, my own dentist for my first 30 years in Rome,
had a delicate touch and was a whiz with the Xylocaine. Once, though, I had an
emergency while Nino was out of town, and when his substitute leaned on my
shoulder for leverage it came close to dislocating. The day they gave a lesson
on how to handle flesh gently he must have played hooky. I told my beloved Nino
he’d handed me over to a backup who was oblivious to patient comfort. He
answered with a sigh: “Yes, I know, he’s a little rough. He knows his stuff,
but until now he’s been working in the National Health Service. He still needs
to learn how to behave with private patients.” That’s all I know from personal
experience about public dentistry, and all I need to know.

Saturday, June 23, 2018

Allergy
emergency take one: Charles was on vacation in Tuscany when he got stung by a
bee, felt his throat start to close, and headed for the nearest Emergency Room.
They recognized impending anaphylactic shock and knew there’s only one way to
be sure it won’t be lethal: a shot of adrenalin, which starts working in
seconds. The docs gave him the injection, Charles felt better, he stayed under
observation the rest of the afternoon, he went home with a prescription for a
few days of pills. Ordinary modern medical care.

Allergy emergency take two:
Margherita knew she was horribly allergic to nuts. The scoop for her coffee and
coconut gelato must have been dipped first in hazelnut or walnut flavor,
because she felt her chest begin tightening up. Off to her local hospital,
where things started going sideways. The head of the Emergency Room didn’t
believe in adrenalin. So his staff gave her only a shot of cortisone, which
doesn’t start to have an effect for hours. By the time the medication did kick
in Margherita was struggling to breathe. She was lucky, and survived to tell me
the tale.

In the first decades I worked here
the anti-adrenalin school held sway in Italian Emergency Rooms, at least those
within range of Rome. By now things have improved considerably, and most
patients who need it do get that magic injection of adrenalin in the Emergency
Room.

But though we’re well into the 21st
century, I’d estimate that the bad old
policy still holds sway at about one ER out of six – which means Russian
Roulette for anyone who might be going into anaphylactic shock. One of those
eternal Italian mysteries, like why secretaries always tell you to call back
instead of taking a message.

Last
month a patient provided a scary new twist on the allergy theme: when her
throat started closing up at 3 am she rushed to an ER, walked up to the glass
barrier with her head tipped backward (the only way any air could get in), and
told the triage nurse she couldn’t breathe. The nurse told her to go sit in the
waiting room. Three hours later she and all the 15 other supplicants hadn’t
seen the shadow of a doctor. Since her throat still hadn’t closed altogether my
patient figured she’d live, and went home.

Moral
of the story: if you’re visiting Italy and know you have a potentially
life-threatening allergy, be sure you bring along an up-to-date Epipen. Locals
can obtain the equivalent free at
public hospitals, but it can be very difficult to find one being sold in
regular pharmacies.

Monday, June 18, 2018

In the days before
there were fixed airport rates and before all New York cabs were driven by
foreigners who can’t tell Brooklynese from a southern drawl, I used to ratchet up my
native Noo Yawk accent when climbing into a cab at JFK, to let the
driver know I was a local and thus avoid being chiseled. Not good enough: once
I was so sleepy heading to midtown Manhattan at 3 AM I didn’t notice I was
being driven all along the Brooklyn seashore, doubling both the mileage and the
tab.

But when it comes to fleecing
passengers, Rome
cabbies take the prize. A team of investigative reporters in the 1990s found
that half the foreigners who take a taxi from the Da Vinci airport in Fiumicino
got cheated. Nobody wasted gas on extra mileage like my New York cabbie – they’d
just tell a packed cab that the meter rate was per person. Legit cabbies can’t
pull that trick now that they have to post their rates in four languages, but tourists
emerging from International Arrivals still run a gauntlet of unlicensed swindlers
muttering “Taxi? Taxi?”

One taxi driver confided to me on the long drive to
the airport that before taking off for a vacation elsewhere in Italy he always
checked out ahead of time what the cab fares were supposed to be at his destination, assuming
that his colleagues there would try to rip him off.

I once went to the American
Embassy to plead an employee’s compensation case in front of a State Department
lawyer who had been flown in from the States for the occasion. The lawyer had obediently
followed the Department’s penny-pinching guidelines and taken a bus to town
from the airport instead of spending 25,000 lire on a cab. When he got out at
the bus station, he told me, he took a taxi straight to the Embassy half a mile
away – had the 30,000 lire he’d paid been the right price? I had to break the
news that on the meter it would have been about 3,000. His round pink innocent
face had “Take me for a ride” written all over it.

But this is Italy, so you
never know – another time the meter reads €10.50 and the cabbie says
just give me ten.

Visitors take note: Italian cabbies don’t expect tips! And the
fixed rates from Rome’s airports into town include your luggage!

Wednesday, June 6, 2018

The book I’ve been working on for
more than 30 years, about my adventures practicing medicine in Rome, has been
accepted for publication!!! Paul Dry
Books in Philadelphia, is planning to bring it out in spring 2019 under the
title Dottoressa: An American Woman Doctor In Rome, and hopes to get it
published in Italian some time thereafter. Paul Dry is a wonderful small
independent publishing house, with focus on the intellectual and the quirky,
and I’m proud to be in the company of its authors. The book is entirely
independent of the blog – even assiduous blog fans will find it all new
material.

Wednesday, May 30, 2018

When I was maybe five a doctor friend
of my parents, Arthur Shapiro, gave me a stethoscope he was finished with. I was
thrilled – not about putting the plugs in my ears and listening, but by having a
real object, a fetish from the grownup world. Next to that my toy doctor's kit
with its little bottle of pink sugar pills paled by comparison.

Drawing by Suzanne Dunaway

For checkups my
brother and I would get driven all the way from Flushing across the 59th Street
Bridge to the pediatrics department in the white towers of New York Hospital. All
I remember about Dr. Fraad* is he once reassured my mother about my baby toenail
that she thought was growing in funny. Sixty years later I showed her the same
toenail and she was still unconvinced.

Most of the time I kind of liked
being sick. Sickness turned on my mother’s Fair Illness Code. You got to eat
apple sauce with pills crushed up inside, if you had a fever of 100° you got to
stay home from school, and after the fever was gone you had a right to one
extra day at home. Once during a high fever I hallucinated climbing a huge
mountain without ever getting to the top, like Sisyphus with his stone, and I remember
I considered it great fun – delirium as a natural psychedelic.

But once when I had an earache I
remember my mother weeping helplessly at my bedside. I must have been howling
in pain myself, but the sight of her in tears was so astonishing that it’s all
that’s stuck in my memory. The torment of another earache stuck in memory as an
engulfing red ball that expanded bigger and bigger. The doctor came to the
house, I can still see him looming over my bed, but the pain only stopped when
my eardrum burst the next day. I found it wonderful to have no hearing from my
right ear, and kept rubbing the outside to test it.

Medicine didn’t have much of a
presence in my young universe, but expatriation did. Many of our family friends
had fled the Nazis, and as Jews by origin if not religion my parents always kept
their mental bags half-packed for a quick exit. Which is why my father once
suggested that I should become a doctor, advice I scorned for decades. His reasoning
was that – in the worst case scenario – I could instantly set up shop as a
physician anywhere in the world. He didn’t, needless to say, know Italian
bureaucracy!

*added October 12, 2018:
An
email from a reader set me to googling Dr. Fraad. I learned from his New York
Times obituary
that he was indeed distinguished enough to be worth the trip across the bridge –
Benjamin Spock cited him as an influence – and that he was an active left-winger,
possibly a Communist,
instrumental in sparking the famous 1969-71 health workers’ collective at Lincoln Hospital
in the Bronx. You can hear him speakhere, very
near the beginning.

About Me

I moved to Rome in 1978 after finishing my training in New York, and have been practicing primary care internal medicine there ever since, treating a clientele that’s featured Roman auto mechanics and British ambassadors, Indonesian art restorers and Filipina maids, Russian poets and Ethiopian priests. When not seeing patients, doing research in psychosomatic medicine, or being the Artist's Wife to my composer husband, I've written a book about my medical adventures, Dottoressa: An American Doctor In Rome, to be published by Paul Dry Books in May 2019.